The relationship between physical activity and low back pain outcomes: a systematic review of observational studies

• Published in: European spine journal Vol. 20; no. 3; pp. 464 - 474
• Main Authors: Hendrick, Paul, Milosavljevic, S., Hale, L., Hurley, D. A., McDonough, S., Ryan, B., Baxter, G. D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2011; Springer Nature B.V
• Subjects: Activities of Daily Living - psychology; Backache; Data processing; Disability Evaluation; Exercise; Exercise Therapy - methods; Hand; Handicapped; Humans; Leisure; Leisure Activities - psychology; Low back pain; Low Back Pain - rehabilitation; Measurement; Medicine; Medicine & Public Health; Neurosurgery; Pain; Patients; Physical activity; Physical Fitness - physiology; Physical Fitness - psychology; Physical training; Research (statistical design); Review; Review Article; Spine; Statistical analysis; Statistics; Surgical Orthopedics; Systematic review; Physical activity; Low back pain; Outcomes; Guidelines
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-010-1616-2

Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain (NSLBP), the link between levels of physical activity and outcomes is unclear. This systematic review investigated the relationships between free living activity levels after onset of low back pain (LBP) and measures of pain, and disability in patients with NSLBP. Cohort and cross-sectional studies were located using OVID, CINAHL, Medline, AMED, Embase, Biomed, PubMed-National Library of Medicine, Proquest and Cochrane Databases, and hand searches of reference lists. Studies were included if a statistical relationship was investigated between measures of free living physical activity (PA) in subjects with LBP and LBP outcome measures. Twelve studies (seven cohort and five cross-sectional) were included. One prospective study reported a statistically significant relationship between increased leisure time activity and improved LBP outcomes, and one cross-sectional study found that lower levels of sporting activity were associated with higher levels of pain and disability. All other studies ( n  = 10) found no relationship between measures of activity levels and either pain or disability. Heterogeneity of study designs, particularly in terms of activity measurement, made comparisons between studies difficult. These data suggest that the activity levels of patients with NSLBP are neither associated with, nor predictive of, disability or pain levels. Validated activity measurement in prospective research is required to better evaluate the relationships between PA and LBP.